Hypothyroid and confused about Synthroid dose

Hello - I guess I'll start with a history of what has happened to me and hopefully the doctor can give me some insight.I am a 28 year old female and after a couple of months of fatigue and muscle soreness I was diagonsed as hypothyroid with a TSH of 18.96 towards the end of July.  I am 5'4" and 110 lbs (although I was 120 at the time) and my initial dose of Synthroid was 100mcg.  After the first week, I did start to notice a difference physically, I definitely felt better, but was having trouble sleeping and very anxious.  I also lost my job at around the same time so that could also account for a lot of my anxiety.  After four weeks my TSH was tested again, but this time it was .06 so my dose was reduced to 50mcg.  After a week or two, I began to feel like my muscle soreness was returning but definitely not as bad as I was in the beginning.  After another four weeks after the dose change, I was tested again and my TSH only rose to .08.  That was last week.  I am now on the lowest dose of Synthroid they make (I think)  25mcg.  I don't know what to make of how I feel - I do have a lot of strength it seems with heavy things, but while whisking eggs the other day my arm felt sore - doesn't seem to make sense to me. My hair loss is also out of control.  I don't have my first endo appt until the end of october so I was hoping someone could give me some insight/advice.  My mother has also been hypothryoid since her mid forties.  Thank you so much - I'm so confused and my husband and I are eager to start trying to conceive our first child but want this thyroid in order first.

[Mark Lupo, M.D.]

The synthroid dose needs to be slowly adjusted and then TSH checked after 6-8 weeks -- it may be that your dose was lowered too significantly.  The other possibility is that you don't need synthroid and that the elevated TSH over the summer was a transient situation (ie, recovering from thyroiditis) - if the TSH was repeated 4-6 weeks after the first abnormal test and was still high - likely you need the synthroid - or if antibodies positive - likely you need the synthroid.

With planning a pregnancy in the near future my advice would be to get the TSH around 1 with 50, 75 or 88mcg of synthroid and keep TSH constant until done with child-bearing -- after child-bearing, re-consider if the synthroid is really needed....

[Jen612]

Thank you so much for answering.  I've been doing so much reading on the internet which at times can give peace of mind and other times can scare.  I have to be honest that I was hoping it would be a thyroiditis situation because that would mean that I could recover.  I kind of thought it was unlikely given that my mother and her sister are also hypothyroid - but they were not diagnosed until their forties.  Do my TSH numbers suggest an average case of hypothyroid?  How rare is thyroiditis?  Is it similiar to a viral or a bacterial infection of the thyroid that can eventually go away?  I'm sorry for all of the questions but I am just so nervous about having a hypothyroid pregnancy that I feel like I'm grasping at anything.  I kept telling my mom that if I had a couple of healthy children, I wouldn't care about being hypo and I wouldn't care how long it would take to regulate - I can deal with it.  Its just at this stage in my life I am so scared.  Thank you so much for your time Dr. Mark.  If anyone else reading has heard of someone having thyroiditis and recovering can you please respond?  Thanks so much.

[Mark Lupo, M.D.]

Thyroiditis is fairly common - the TSH you mentioned could be either from true hypothyroid or the recovery from thyroiditis.  We think thyoroiditis is an inflammation due to virus or another infection and 85% of people recover fully.  The family history is important - so check antibodies.  Most hypothyroid women have healthy babies if they are monitored properly.

[Jen612]

Thanks so much Dr Mark for easing my mind. I'm just worried that the 25mcg dose might be too high again and then what will I do? I guess I will have my antibodies checked when I finally see an endo at the end of this month.  You are providing such a wonderful service giving so many people peace of mind.

[cpombr]

A related discussion, Trouble with synthroid was started.

[rikitik]

A related discussion, HYPOTHYROIDISM was started.